Provider Demographics
NPI:1558388595
Name:NUN, SAMUEL (MD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:NUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 BEACON ST
Mailing Address - Street 2:#301
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:617-734-9061
Mailing Address - Fax:617-232-3821
Practice Address - Street 1:1842 BEACON ST
Practice Address - Street 2:#301
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445
Practice Address - Country:US
Practice Address - Phone:617-734-9061
Practice Address - Fax:617-232-3821
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38507207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B95211Medicare UPIN
MAC04715NUMedicare ID - Type Unspecified